Sharon Regional Health System jobs - 136 jobs

Department Name: Coding-Acute Care Compl & Educ Work Shift: Day Job Category: Revenue Cycle Estimated Pay Range: $29.11 - $48.51 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Innovation and highly trained staff. Banner Health recently earned Great Place To Work Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we're constantly improving to make Banner Health the best place to work and receive care. Interested in joining our Coding team? We have great opportunities, whether you're looking for entry-level or have been coding for years! Requirements for each position noted below. Not the right fit for you? Keep looking! We have a lot different teams with different focuses (Facility vs Profee). In this Inpatient Facility-based HIMS Coding Quality Associate position, you bring your 5 years of acute care inpatient coding background to a team that values growth and development! This is a Quality position, not a day-to-day coding production role but does require coding proficiency and recent Hospital Facility Coding experience. This position is task-production-oriented ensuring quality in the Inpatient Facility Coding department. If you have experience with DRG and PCS coding/denials/audits, we want to hear from you. Schedule: Full time, Monday-Friday 8am-5pm during training. Flexible scheduling after completion of training. Location: REMOTE, Banner provides equipment Ideal candidate: 5 years recent experience in acute-care Inpatient facility-based medical coding (clearly reflected in your attached resume); DRG and PCS Coding, Auditing experience; Bachelors degree or equivalent; Must be currently certified through AAPC or Ahima, as defined in minimum qualifications below. Please upload a copy or provide certification number in your questionnaire. This is a fully remote position and available if you live in the following states only: AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, MI, MN, MO, MS, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI & WY. Interested in joining our Coding team? We have great opportunities, whether you're looking for entry-level or have been coding for years! Requirements for each position noted below. Not the right fit for you? Keep looking! We have a lot different teams with different focuses (Facility vs Profee). Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position is responsible for the interpretation of clinical documentation completed by the health care team for the health record(s) and for quality assurance in the alignment of clinical documentation and billing codes. Works with clinical documentation improvement and quality management staff to: align diagnosis coding to documentation to improve the quality of clinical documentation and correctness of billing codes prior to claim submission; to identify possible opportunities for improvement of clinical documentation and accurate MS-DRG, Ambulatory Payment Classification (APC) or ICD-10 assignments on health records. Provides guidance and expertise in the interpretation of, and adherence to, the rules and regulations for code assignment based on documentation for all levels of complexity to include accounts encountered in Banner's Academic, Trauma, high acuity and critical access facilities, as well as specialized services such as behavioral health, oncology, pediatric. Acts as subject matter expert regarding experimental and newly developed procedure and diagnostic coding. CORE FUNCTIONS 1. Provides guidance on coding and billing, utilizing coding and billing guidelines. Demonstrates extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group (APR-DRG) and Ambulatory Payment Classification (APC) or utilized operational systems. Provides explanatory and reference information to internal and external customers regarding coding assignment based on clinical documentation which may require researching authoritative reference information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper reimbursement and that coding compliance is complete. Provides feedback on coding work and trends, and offers suggestions for improvement where opportunities are identified. Reviews accuracy of identified data elements for use in creating data bases or reporting to the state health department. If applicable, applies Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and co morbid condition, other diagnoses, and significant procedures which require coding. Apply policies and procedures on health documentation and coding that are consistent with official coding guidelines. 3. Assists with maintaining system wide consistency in coding practices and ethical coding compliance. If applicable, initiates and follows through on physician queries to ensure that code assignment accurately reflects the patient's condition, treatment and outcomes. Identifies training needs for coding staff. Serves as a team member for internal coding accuracy audits and documents findings. 4. Acts as a knowledge resource to ancillary clinical departments, patient financial services and revenue integrity analysts regarding charge related issues, processes and programming. Participates in company-wide quality teams' initiatives to improve coding and clinical documentation. Assists with education and training of staff involved in learning coding. Assists in creating a department-wide focus of performance improvement and quality management. Assists and participates with management through committees to properly educate physicians, nursing, coders, CDM's, etc. with proper and accurate coding based on documentation for positive outcomes. 5. Performs ongoing audits/review of inpatient and/or outpatient medical records to assure the use of proper diagnostic and procedure code assignments. Collaborates on DRG and coding denials, billing edits/rejections to provide coding expertise to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials utilizing multiple platforms and internal tracking tools. Provides findings for use as a basis for development of coding education and audit plans. 6. Maintains a current knowledge in all coding regulatory updates, and in all software used for coding, coding reviews and health information management for the operational group. Identifies and collects data to allow for monitoring and evaluation of trends in DRG (MS/APR-DRG), APC, HCC, other Heath Risk Adjusted Factors, National Correct Coding Initiative (NCCI) and the effect on Case Mix Index by use of specialized software. 7. May code inpatient and outpatient records as needed. Works as a member of the overall HIMS team to achieve goals in days-to-bill. 8. Works independently under limited supervision. Uses an expert level of knowledge to provide coding and billing guidance and oversight for all Banner facilities and services they provide. Internal customers include but are not limited to medical staff, employees, and management at the local, regional, and corporate levels. External customers include but are not limited to, practicing physicians, vendors, and the community. MINIMUM QUALIFICATIONS Requires a level of education as normally demonstrated by a bachelor's degree in Health Information Management or experience equivalent to same. Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required. Requires Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) or Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) or Certified Coding Specialist-Physician (CCS-P) or Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) or other qualified coding certification in an active status with the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC). Demonstrated proficiency in hospital coding as normally obtained through 5 years of current and progressively responsible coding experience required. Must possess a thorough knowledge of ICD Coding and DRG and/or CPT coding principles, as recommended by the American Health Information Management Association coding competencies. Requires an in-depth knowledge of medical terminology, anatomy and physiology, plus a thorough understanding of the content of the clinical record. Extensive knowledge of all coding conventions and reimbursement guidelines across services lines, LCD/NCDs and MAC/FIs. Extensive critical and analytical thinking skills required. Ability to organize workload to meet deadlines and maintain confidentiality. Excellent written and oral communication skills are required, as well as effective human relations skills for building and maintaining a working relationship with all levels of staff, physicians, and other contacts. Must consistently demonstrate the ability to understand the Medicare Prospective Payment System, and the clinical coding data base and indices, and must be familiar with coding and abstracting software, claims processing tools, as well as common office software and electronic medical records software. PREFERRED QUALIFICATIONS Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

Atlantic Health is Seeking Remote Radiologists for Evening and Overnight Shifts - 7 on / 14 off The Radiology Division at Atlantic Health is currently seeking highly skilled and motivated radiologists to join their well-established team as remote radiologists. This is a work-from home position, and all equipment will be provided by Atlantic Health. We are currently seeking radiologists for swing shift positions (typically 3p-midnight but negotiable) as well as overnight positions (10p-8a). Enjoy tremendous work-life balance at a competitive salary. This position requires working 7 days on, and 14 days off. Successful candidates will work with state-of-the-art equipment and cutting-edge technology in a collaborative and supportive environment. As a radiologist with Atlantic Health, you will have access to a diverse patient population and a wide range of diagnostic cases. We are committed to providing our patients with the highest quality care and are looking for radiologists who shares our dedication to excellence. As a remote radiologist with Atlantic Health, you will support the following hospitals: Morristown Medical Center is a 735-bed tertiary, research and academic medical center located in Morristown, NJ. The imaging department produces over 400,000 exams in, CT, MR, Pediatrics, IR, US, NM/PET, plain films, & Breast Imaging for ED, IP and several OP sites. Overlook Medical Center is a 504-bed tertiary referral center for neurosurgery, nonprofit teaching medical center located in Summit, New Jersey. The imaging department produces over 200,000 exams in CT, MR, pediatrics, IR, US, NM/PET, plain films & Breast imaging. Chilton Medical Center has been ranked the top mid-sized hospital in NJ for seven years in a row, according to Castle Connolly. The Leapfrog Group gave us an "A" Hospital Safety Grade and we've received the Lifeline Bronze Receiving Quality Achievement Award from the American Heart Association. The imaging department produces over 130,000 exams per year in CT, MR, pediatrics, IR, US, NM/PET, plain films & Breast imaging. If you'd like to learn more, please send your CV to Lori Velasco, Physician Recruiter, at ******************************* or apply. Salary Range: $450,000-$650,000 base salary only; excludes any quality and/or productivity incentives Benefits * Competitive Compensation * Robust benefits with health, dental, Rx and vision plans * 457 plans offered to physicians, as well as 403b retirement plan with company match * Reimbursement for Relocation * Comprehensive Malpractice Policy * Non-Profit Health System - eligible for Federal Student Loan Forgiveness * Annual CME and Time Off incremental to PTO days * Full reimbursement for Boards and Licensing fees * Tuition reimbursement for Advanced Degrees * Outstanding growth & mentorship opportunities Atlantic Medical Group is a physician-led and physician-governed organization that delivers the highest quality health care, at the right place, the right price, and the right time. We are a multispecialty physician group with more than 1,000 doctors, nurse practitioners and physician assistants at over 300 locations throughout northern and central New Jersey and northeast Pennsylvania. Our mission is to deliver exceptional care recognizing the unique needs of all those we serve. Our vision is to achieve the best outcomes with our patients at the center of the physician-led team, driven by service, innovation and continuous learning. Our integrated network offers seamless access to Atlantic Health System's entire health care continuum and our nationally and regionally ranked hospitals. In collaboration with Atlantic Health System, several of our practices offer urgent care and walk-in services. In addition to primary care physicians, the team includes specialists that care for patients in all aspects of their health from pediatrics to geriatrics and everything in between. We make health decisions easier for patients with enhanced access to referrals. Atlantic Health System offers a competitive and comprehensive Total Rewards package that supports the health, financial security, and well-being of all team members. Offerings vary based on role level (Team Member, Director, Executive). Below is a general summary, with role-specific enhancements highlighted: Team Member Benefits * Medical, Dental, Vision, Prescription Coverage (22.5 hours per week or above for full-time and part-time team members) * Life & AD&D Insurance. * Short-Term and Long-Term Disability (with options to supplement) * 403(b) Retirement Plan: Employer match, additional non-elective contribution * PTO & Paid Sick Leave * Tuition Assistance, Advancement & Academic Advising * Parental, Adoption, Surrogacy Leave * Backup and On-Site Childcare * Well-Being Rewards * Employee Assistance Program (EAP) * Fertility Benefits, Healthy Pregnancy Program * Flexible Spending & Commuter Accounts * Pet, Home & Auto, Identity Theft and Legal Insurance ____________________________________________ Note: In Compliance with the NJ Pay Transparency Act (effective Sunday, June 1, 2025), all job postings will include the hourly wage or salary (or a range), as well as this summary of benefits. Final compensation and benefit eligibility may vary by role and employment status and will be confirmed at the time of offer. EEO STATEMENT Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.

**Per Diem Hospice Medical Directorin Beautiful Northern, CO** **Remote Only & Flexible Schedule** **BANNER HEALTH and the Home Care & Hospice Division** , one of the countrys premier, nonprofit health care networks with more than 1,500 physicians and advance practice providers, **has an excellent opportunity for a compassionate, skilled clinician to join our interdisciplinary team!This position serves the growing community in Northern Colorado in partnership with the current care team.** Utilizing a multidisciplinary approach, the qualified candidate will provide remote support to the Home Care & Hospice team of Advanced Practice Providers. **Position Requirements and Information:** + BC/BE in a relevant specialty + Colorado state licensed + Fellowship training in Hospice & Palliative Medicine - NOT REQUIRED + Experience preferred, new graduates also welcome to apply + Flexible schedule primarily providing back-up coverage for the acting Medical Director **Compensation & Benefits:** + **$140/hr** + Malpractice and Tail Coverage **About the area:** With more than 300 days of sunshine, Northern Colorado is one of the best places to live and work offering spectacular views along the Rocky Mountain Front Range, great weather, endless recreational activities, cultural amenities, education, and professional opportunities. + Within one hour of majestic Rocky Mountain National Park & 90 minutes to world-class ski resorts + Numerous outdoor activities including golf, biking, hiking, camping, rock climbing, hunting, and fishing + Thriving cultural and retail sectors + Highly educated workforce & broad-based business sector leading to substantial growth along the front range + Variety of public and private education options for K-12 and easy access to three major universities **PLEASE SUBMIT YOUR CV TODAY FOR IMMEDIATE CONSIDERATION** As an equal opportunity employer, Banner Health values culture and encourages applications from individuals with varied experiences and backgrounds. Banner Health is an EEO Employer. POS15101 Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.

Find your purpose as a Financial and Regulatory Analyst at CentraCare. The Financial and Regulatory Policy Analyst serves as a cross-functional expert supporting financial analysis, payer policy review, and regulatory compliance. This role is responsible for evaluating the financial and operational impact of payer policies, government reimbursement regulations, and healthcare legislation. The analyst partners with managed care, revenue cycle, government reimbursement, compliance, and clinical operations teams to ensure alignment with payer requirements, optimize reimbursement, and mitigate regulatory risk. Schedule: Full-time 72 hours every 2 weeks Hours between Monday - Friday 8:00a-5:00p CST Fully remote Pay and Benefits: Starting pay begins at $63,747.33 per year and increases with experience. Salary range: $63,747.33-$95,642.90 per year Salary range is based on a 1.0 FTE, reduced FTE will result in a prorated offer rate We offer a generous benefits package that includes medical, dental, flexible spending accounts, PTO, 401(k) retirement plan & match, LTD and STD, tuition reimbursement, discounts at local and national businesses and so much more! Qualifications: Bachelor's degree in Finance, Health Administration, Public Health, Economics, or related field or 5+ years of experience in financial analysis, strong report-building skills, payer relations, or regulatory affairs in a healthcare environment. Understanding of Medicare and Medicaid payment systems, managed care contracts, and payer policies required. Proficiency in Excel and financial modeling; ability to interpret large datasets required. Familiarity with EHR and revenue systems (e.g., Epic, Lawson, Strata, or similar) preferred. Experience with payer audits, prior authorization processes, and coverage policy review preferred. Strong analytical, report creation, and critical thinking skills. Clear written and verbal communication. Regulatory and policy acumen. Detail orientation with the ability to synthesize complex information. Collaboration and stakeholder engagement Core Functions: Payer Policy & Regulatory Intelligence Monitor and interpret payer policy updates, government reimbursement rules (e.g., Medicare, Medicaid, commercial plans), and legislation impacting financial performance. Analyze changes in payer coverage determinations, billing guidelines, and authorization policies to assess impact on access, documentation, and reimbursement. Collaborate with internal stakeholders to implement payer policy changes and ensure compliance across the revenue cycle and clinical departments. Identify opportunities for revenue enhancement and cost reduction through proactive management of payer policies. Financial Analysis & Forecasting Build and maintain financial models to forecast the revenue impact of regulatory or payer policy changes. Analyze variances in net revenue, denials, and reimbursement trends related to policy shifts and provide regular reports to the HealthCare Affordability Committee. Support budget planning and value-based contract modeling by incorporating regulatory and policy data. Develop metrics to track policy compliance, identify gaps, and propose solutions to improve processes and outcomes. Document and communicate findings, recommendations, and action plans to the HealthCare Affordability Committee. Regulatory Compliance & Reporting Track regulatory requirements from CMS, state Medicaid agencies, and commercial payers. Collaborate with compliance teams and revenue integrity teams to implement and maintain internal controls and audits to minimize risk. Collaborate with payer relations to address any payer-policy-related issues. Monitor adherence to payer policies across the organization. Partner with clinical and operational teams to ensure policy changes are implemented efficiently and effectively. Collaborate with the legal department to review and interpret contracts, agreements, and regulations. Communicate effectively with payers to clarify policy details and resolve disputes. Work closely with the revenue cycle management team to optimize claims processing and reimbursement. Cross-Functional Collaboration Act as a liaison between Finance, Compliance, Managed Care, Revenue Cycle, and Clinical Operations teams. Analyze clinical vendor reimbursement assumptions. Deliver policy summaries and financial impact briefs to operational leaders, with clear recommendations. Support stakeholders on new or updated payer policies and regulatory requirements. CentraCare has made a commitment to diversity in its workforce and all individuals, including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.

Find your purpose as a Patient Scheduling Assistant with CentraCare! The Patient Scheduling Assistant (PSA) will work at our South Point location off of Clearwater Road in St. Cloud within a fast-paced team structured call center environment for training, then will move to a work from home structure. The PSA will be answering phone calls from patients calling their primary and specialty care clinics and will be responsible for completing patient registration and scheduling over the phone. This position will have no face-to-face contact with patients. The PSA will also be responsible for providing superior customer service by effectively communicating with a diverse age and ethnic population in an audible, friendly, and professional voice. Schedule * Part-time 40 hours every 2 weeks * Evenings | Wed, Thurs, & Fri 5p-9p; e/o weekend 2p-10:30p; occasional holidays * Work from home after in-person training; in-person training Mon-Fri Day FT hours Pay and Benefits * Starting wage $18.28 per hour; exact pay determined by years of related experience; shift differential pay offered for evenings and wknds. * Pay range: $17.00-$25.54 per hour * Benefits: medical, dental, PTO, retirement, employee discounts and more! * Tuition reimbursement and college grant programs available. Qualifications * High school graduate or equivalent required. * Two years' previous call center or health care experience required. * Associates degree in a related field preferred. * Strong knowledge of computer programs including Microsoft Office Products is required. Approximately 4 weeks in-office for training. CentraCare has made a commitment to diversity in its workforce. All individuals including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.

University of Pittsburgh Physicians is hiring a Full-Time Medical Education Program Academic Manager to help support the Internal Medicine Residency, Department of General Internal Medicine. Hours: Monday-Friday, 8:30 am - 4:30 pm. No evenings or weekends. Location: UPMC Presbyterian Hospital, typically one day WFH per week. Department Details: Working in a Graduate Medical Education department offers a unique opportunity for personal and professional growth in a collaborative working environment working closely with physician teaching faculty, residents/fellows and other departments. Graduate Medical Education career path can lead to career growth and leadership roles within various academic settings. Flexible and remote work options available dependent on academic calendar. Responsibilities: + Utilize Residency Management system (MedHub) to complete various tasks. Tasks may include entering rotation schedules, documenting PTO, LOAs, etc. in lieu of Kronos, monitoring work hour submissions by residents/fellows, uploading required program documentation and policies, maintaining trainee specific credentialing documentation, etc. + Prepare and maintain documentation related to program accreditation requirements (e.g., ACGME, ASHP, CODA or CPME) as well as specialty board requirements. Monitor completion of annual update submissions (e.g., WebADS Annual Update, ACGME milestones, ACGME Resident/Fellow and Faculty Surveys, AMA FREIDA). + Coordinate and maintain documentation pertaining to the UPMC Medical Education Annual Program Oversight Review (APOR) and anticipated required documents that will be requested during accrediting body Site Visits. + Monitor the management of trainee, rotation, faculty, and program evaluations. o Ensure trainees receive documented evaluations at the end of each rotation. If rotations are longer than three (3) month periods, a trainee must have documented evaluations at a minimum of every ninety (90) days. + Coordinate Program Evaluation Committee (PEC) and Clinical Competency Committee (CCC) meetings including scheduling, preparing agenda, meeting materials, program/trainee evaluation analytics, and meeting minutes. + Develop and maintain program recruitment resources such as brochures, PowerPoint presentations, websites, and other social media outlets as necessary. Maintain skills and knowledge needed to remain competitive and support recruitment efforts in a primarily virtual landscape. + Construct productive working relationships and act as a liaison between trainees, program directors, hospital administration, UPMC ME central team, additional internal departments, staff, and other hospitals, as necessary. + Regularly attend UPMC ME sponsored meetings and retain knowledge of information presented for updates to process change and adjustments in work requirements. + Manage the planning and execution of live/virtual meetings, conference, lectures, and other events including recruitment, orientation, and program celebrations. Organize, prepare, and distribute materials as needed. + Provide UPMC ME with information on incoming trainees required in the credentialing process, for issuance of a new hire contract and paperwork (including but not limited to items such as licensing, visas, and clearances). Communicate with incoming residents/fellows to ensure timely submission of documentation for hire. Complete all program specific tasks associated with hire (e.g., computer access requests, parking applications, office/phone assignments) and partner with program leadership to provide program specific new hire orientation. + Submit confirmation of trainee termination (including program completion) to UPMC ME including processing requests for completion certificates, collection of UPMC property (e.g., identification badges, laptops, pagers). + Process expense submissions for the trainees and department and track utilization of program specific funds. Submit documentation for supplemental pay processing as necessary for Clinical Skills Enhancement (CSE) Activities. + Serve as supervisor for UPMC compliance oversight for trainee employment including but not limited to mandatory module complete, employee health reporting requirements, expense approvals, etc. + This position involves high level administration in Department of Medicine academic affairs. + Responsible for management of General Internal Medicine residency and fellowship training programs. + Ensures and oversees GIM Training programs maintaining compliance with residency and fellowship program accreditation policies and annual training requirements and that are consistent and compatible with those adopted by the University of Pittsburgh Medical Center, University of Pittsburgh Medical Center Medical Education Program, University of Pittsburgh Physicians, UPMC Hospital and other accreditation organizations. + Responsible for all aspects of the residency and fellowship applicant interview process with file management via the Electronic Residency Application Service, including process improvement. + Oversight and audit appropriate data systems for residency and fellowship program assessment, accreditation, and reporting, including trainee entry in the Accreditation Council for Graduate Medical Educations OP Log (procedure reporting), online evaluation system, resident work hour entry into the UPMC Graduate Medical Education ROCS system, and others. Facilitate submission of all documents for and monitors maintenance of appropriate licensure, visas and certification of residents/fellows. + Maintain budgets and tracking related to trainee stipends and expenditures. + Serve as liaison with program directors, trainees, and GME leadership. + High School or equivalent and 4 years of Medical Education experience + OR a Bachelor's Degree and 2 years of experience in Medical Education required Licensure, Certifications, and Clearances: + Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

The HRIS Analyst is responsible for the administration, optimization, and support of Human Resources Information Systems to ensure data integrity, system effectiveness, and an exceptional employee and manager experience. This role partners closely with HR, IT, Payroll, Benefits, Onboarding and other stakeholders to translate business needs into scalable system solutions, leveraging automation, integrations, reporting, and process improvements. Assist the HRIS team in development and upgrades of new or existing modules, programs and applications. Configure, maintain, and support HR Systems (e.g., HCM Core, Talent, Profile, Absence, Journeys, Self-Service, ServiceNow HRSD) Manage effective-dated changes, system validations and ongoing maintenance. Troubleshoot system issues, analyze root causes, and coordinate resolution with vendors and IT partners. Partner with HR Stakeholders to understand HR processes to reduce manual effort and improve accuracy. Utilizes software to manage upload and download processes, to include MS Add-is when appropriate when appropriate for mass data entry Consults with system users to identify data needs. Develops and maintains reports and queries to provide data to management and human resources staff as needed. Determines how best to address request through enhancing existing software functionality, reporting, system configuration, or data export. Ensures all data distribution is on a need-to-know basis and authorized by HR Management. Maintain system documentation, job aids, and process flows. Liaise with system vendors and third-party providers to resolve issues and implement enhancements. Support integrations between HR systems and downstream or upstream applications. Schedule: Full-time | 80 hours every two weeks Day shift | Monday - Friday | 8:00 a.m. - 5:00 p.m. This role will work remotely Pay and Benefits: Pay begins at $68,939.12 annually, exact pay determined by years of experience Pay Range: $68,939.12 - $103,441.54 annually Full-time benefits: medical, dental, PTO, retirement, employee discounts and more! Qualifications: Bachelor's degree in Human Resources, Computer Science, Management Information Systems, or a related field 3+ years of analyst experience supporting HRIS platforms in a medium to large organization Experience with workflow automation, Journeys or other case management tools Reporting experience and SQL knowledge preferred Experience supporting system implementations or major upgrades preferred Advanced Excel and/or BI reporting skills preferred Oracle, UKG, ServiceNow or other application certifications preferred CentraCare has made a commitment to diversity in its workforce. All individuals including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.

Codes patient records capturing all diagnosis and procedures to accurately reflect the patient's encounter. Assignments are either Inpatient; Emergency room or Observation records (which includes charging; outpatient cardiac catheterizations, surgical, or minor procedure records. ER productivity average = 60-65/day Observation productivity average= 21/day Surgical and Cardiac Cath productivity average = 30/day Minor procedure productivity average = 50-60/ day Charges the ER admission cases via the Charge Capture ER WQ. Avg production = 85/day Monitors the Coding Priority DAILY and ER Charge Capture Priority WQs throughout the day as to clear cases each day. Utilizes the Interact Query process for any provider clarifications needed. Meets 95% or greater in all coding and charging accuracy. No case shall remain on these WQs for >3 days. Required: High School Diploma or equivalent. AHIMA coding certification, CPC, CCS or CCA Minimum 1 year of coding experience in an acute care setting or relevant. Proficiency in medical terminology, anatomy/physiology, disease processes. Proficiency in CPT4, E/M, ICD-10 coding. Preferred: Prior admin or assistant experience. #LI-AW1

While this position will collaborate closely with UPMC, it will be a contract role employed by Strategic Consulting Partners (SCP). The Care Manager Associate (CMA) position will be part of the UPMC Health Plan's Community Services Community Paramedic Team. The team expands paramedic roles from emergency care to a focus on non-emergent and preventative health services tailored to individuals' needs and goals. The CMA will begin their journey in mobile care management while helping resolve members' SDOH issues, develop a community resource knowledge-based understanding while collaborating with multidisciplinary resources and providers, and manage referrals using administrative skills for the Health Plan's one of a kind's homebound vaccination program. All this significantly positively impacts members' health and well-being. The CMA works business hours in a hybrid work structure, with minimum weekend, after hours, or holiday coverage as needed by the department. This is a flexible community-based position that requires travel to hospitals, provider sites, and member residences within Allegheny County. After the successful completion of orientation and training, this role works remotely when not out in the community! In collaboration with the Community Paramedic team the CMA coordinates the appropriate support services and resources throughout the Community Services Team at UPMC Health Plan to facilitate effective care plans that achieve optimal satisfaction, and clinical, and financial outcomes along the defined continuum of care. Through the CMA's collaborations, practical comprehension and hands-on experience in clinical care/utilization management will result by collecting and assisting with face-to-face documentation for complex care management assignments. This opportunity will also build on communication and administrative skills during vaccination season by supporting the homebound vaccination processes. The Health Plan Community Services Team is a multidisciplinary team providing mobile face-to-face interactions in the community to address any physical or behavioral health conditions and/or social determinants of health needs that might be negatively impacting the health and well-being of their members. The Community Services team is composed of several smaller specialized teams that provide intense case management and mobile interventions to best serve the communities in which they live and work. Strategic Consulting Partners (SCP) is an award-winning, woman-owned, minority, small business. As a member of the SCP organization you will work as a contractor for UPMC to improve the health and well-being of the UPMC Health Plan members in our communities. Benefits Available through SCP include: + Medical insurance + Vision insurance + Dental insurance + Disability insurance + 401(k) + Paid Time Away from Work: 11 Paid Holidays and 2 weeks PTO your first year Responsibilities + Review Health Plan data for services the member has received and identify gaps in care based on clinical standards of care. + Assist clinical team with scheduling transportation, scheduling appointments, and tracking utilization. + Refer members to appropriate case management, health management, or lifestyle programs based on assessment data. + Assist members with non-medical needs that affect health and access to care. + Successfully engage member in developing an individualized plan of care in collaboration with the member's care team. + Document all activities in the Health Plan's care management tracking system following Health Plan standards based on information obtained from interaction with members and providers. + Recognize and demonstrate shared accountability in development of a care plan with the member/caregiver as well as the team members to ensure optimal outcomes. + Advocate on behalf of patient/family/caregivers for services access and for the protection of the patient's health, wellbeing, safety and rights. + Maintain an understanding of all health benefits and remains current on covered or in-plan services, benefit limitations, exclusions, and health management policies and procedures. + Interfaces with and refers members to community-based resources and other supportive services as appropriate. + Performs in accordance with system-wide competencies/behaviors. + Performs other duties as assigned. + Bachelor's degree in social work or associate degree in another health or human services field that promotes the physical, and psychosocial well-being of those being served. No license is required. + Managed care experience preferred. + Ability to interact with other health care professionals in a professional manner required. + Computer efficiency is preferred. Excellent verbal and written communication and interpersonal skills are required. Knowledge of community resources is preferred. + Value for and ability to deliver excellent customer service. **Licensure, Certifications, and Clearances:** + Act 34 + Act 33 + Act 73 + CPR Certification preferred **UPMC is an Equal Opportunity Employer/Disability/Veteran**

Department Name: Amb Billing & Follow Up Work Shift: Day Job Category: Revenue Cycle Estimated Pay Range: $18.02 - $27.03 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Innovation and highly trained staff. Banner Health recently earned Great Place To Work Certification. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we're constantly improving to make Banner Health the best place to work and receive care. Our PFS Representatives are a crucial part of revenue cycle involving reducing AR and improving patient experience firsthand, post-care. As a member of the PFS Rep CBO, Billing Follow-up Denials Mgt team, you will work with the Insurance companies on behalf of the patient to assist with obtaining payments for our Acute teams and/or Ambulatory teams. In this role, you'll bring your experience with EOBs and medical claims experience to research and hold payers accountable to pay the expected rates according to the contracts in place with Banner Health, within the allowed timeframes. Experience with different payers is a plus, along with knowledge for various denials, such as no authorization, eligibility denials, etc. Schedule: Full time, Monday-Friday, 8hr shifts, typically 8am-5pm (depending on team) Location: REMOTE, Banner provides equipment Ideal candidate: * 1 year patient financial services (Central Billing) or medical claims experience (clearly reflected in attached resume); * Experience with submitting appeals and understanding of EOB; * General knowledge of codes used for claim processing. This can be a remote position if you live in the following state(s) only: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV, WY Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position coordinates and facilitates patient billing and collection activities in one or more assigned areas of billing, payment posting, collections, payor claims research, and other accounts receivable work. Works as a member of a team to ensure reimbursement for services in a timely and accurate manner. CORE FUNCTIONS 1. May be assigned to process payments, adjustments, claims, correspondence, refunds, denials, financial/charity applications, and/or payment plans in an accurate and timely manner, meeting goals in work quality and productivity. Coordinates with other staff members and physician office staff as necessary ensure correct processing. 2. As assigned, reconciles, balances and pursues account balances and payments, and/or denials, working with payor remits, facility contracts, payor customer service, provider representatives, spreadsheets and the company's collection/self-pay policies to ensure maximum reimbursement. 3. May be assigned to research payments, denials and/or accounts to determine short/over payments, contract discrepancies, incorrect financial classes, internal/external errors. Makes appeals and corrections as necessary. 4. Builds strong working relationships with assigned business units, hospital departments or provider offices. Identifies trends in payment issues and communicates with internal and external customers as appropriate to educate and correct problems. Provides assistance and excellent customer service to these internal clients. 5. Responds to incoming calls and makes outbound calls as required to resolve billing, payment and accounting issues. Provides assistance and excellent customer service to patients, patient families, providers, and other internal and external customers. 6. Works as a member of the patient financial services team to achieve goals in days and dollars of outstanding accounts. Reduces Accounts Receivable balances. 7. Uses systems to document and to provide statistical data, prepare issues list(s) and to communicate with payors accurately. 8. Works independently under general supervision, following defined standards and procedures. Reports to a Supervisor or Manger. Uses critical thinking skills to solve problems and reconcile accounts in a timely manner. External customers include all hospital patients, patient families and all third party payers. Internal customers include facility medical records and patient financial services staff, attorneys, and central services staff members. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge. Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently. Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences. Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required. PREFERRED QUALIFICATIONS Work experience with the Company's systems and processes is preferred. Previous cash collections experience is preferred. Additional related education and/or experience preferred. Anticipated Closing Window (actual close date may be sooner): 2026-05-15 EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

Department Name: IT Network Services Work Shift: Day Job Category: Information Technology Estimated Pay Range: $40.91 - $68.19 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Banner Health was named to Fortune's Most Innovative Companies in America 2025 list for the third consecutive year and named to Newsweek's list of Most Trustworthy Companies in America for the second year in a row. We're proud to be recognized for our commitment to the latest health care advancements and excellent patient care. Our team is Firewall Services within the Banner Infrastructure department and our team supports all perimeter Palo Alto firewalls that protect all hospitals, clinics, MOBs, Cloud, Data Centers, etc. from security breaches such as patient PHI and PII data. As Banner continues to leverage technology to deliver the highest quality of possible care, Cybersecurity is a top priority. Firewalls Services is responsible for planning, implementing, managing, monitoring, and upgrading security measures for the protection of the organization's data, systems, and networks as well as troubleshooting security and network platforms. This position ensures that the organization's data and infrastructure are protected from insider and outsider threats by enabling the appropriate security controls while responding to all system and/or network security breaches. As a Cybersecurity Engineer II, you will be on the front lines and help investigate and remediate cybersecurity incidents, escalate cybersecurity incidents as defined by procedure, and help liaise closely with other teams to ensure the correct response and remediation of cybersecurity incidents. Also in the CSE II role, you will be an innovator and SME within design and architecture as well as helping see Cyber Security projects through to completion within the Banner team. The typical schedule for this role is Monday - Friday 8AM - 5PM AZ time. This can be a remote position if you live in the following states only: AL, AK, AZ, AR, CA, CO, GA, FL, IA, ID, IN, KS, KY, LA, MD, MI, MO, MN, MS, NH, NM, NY, NC, ND, NE, NV, OH, OK, OR, PA, SC, TN, TX, UT, VA, WI, WV, WA, & WY Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position designs, develops, configures, implements, tunes, maintains solutions, resolve technical and business issues related to cybersecurity threat & vulnerability management, identity management, security operations center, forensics, and data protection. Cybersecurity Engineers work with Cybersecurity Architects to execute strategic cyber initiatives, evaluate security components of the network, applications and end-user devices, and provides guidance to ensure new systems meet regulatory and technical standards. Cybersecurity Engineers participate in root-cause analysis efforts to determine improvement opportunities when failures occur. Manage Cyber systems, ensures they are tuned, on the current release and manages appropriate change management across the IT organization and the business. CORE FUNCTIONS 1. Leads in the design and implementation of cybersecurity solutions. 2. Leads in providing technical expertise and support for cybersecurity solutions, including operational aspects of the software, hardware, network/firewall. 3. Leads in the design, implementation, and compliance of secure configurations for applications and infrastructure components. 4. Leads in technical assessments of systems and applications to ensure compliance with policy, standards and regulations. 5. Leads in the ongoing evaluation and development of security policies and procedures. Leads the revision of policies and procedures, as needed. 6. Serves as technical lead of cybersecurity projects, including the development of project scope requirements, cybersecurity product implementation, tuning, operational support model creation. 7. Under general direction, this position is responsible for cybersecurity across multiple departments system-wide and requires interaction at all levels of staff and management. Work closely on cross functional IT Teams. MINIMUM QUALIFICATIONS Must possess strong knowledge of business, information security and/or computer science as normally obtained through the completion of a bachelor's degree in Computer Science, Information Security, Information Systems, or related field. Four to six years of experience of enterprise-scale information security engineering, preferably in healthcare. Must also possess one to three years' experience in a healthcare environment or an equivalent combination of relevant education, technical, business and healthcare experience. Experience, IT operations, automation of cybersecurity processes, coding and scripting languages, ability to document cybersecurity processes as well as use case development. Experience with the assessing cyber products, including vendor selection, define requirements, contractual documentation development. Experienced in planning, designing and implementing cybersecurity solutions. Experienced in operating, maintaining and implementing, upgrading and lifecycle of cybersecurity solutions. Proficient understanding of regulatory and compliance mandates, including but not limited to HIPAA, HITECH, PCI, Sarbanes-Oxley. Advanced knowledge of Security Engineering Principles, including risk management, resilience, vulnerability management, Information Security, NIST, MITRE ATT@CK, etc. Expertise in Cyber products supporting Data Loss Prevention, EDR, AntiVirus, Perimeter services, Threat systems, cyber platform analytics, SIEM, CASB, CLOUD Security, ETC. Requires independent judgment, critical decision making, excellent analytical skills, with excellent verbal and written communications. Ability to think quickly under difficult or complex conditions and clearly communicate to appropriate staff; ability to balance project workloads with customer support and on-call demands. Must demonstrate knowledge of information technology and information security principles and practices. Requires communication and presentation skills to engage technical and non-technical audiences. Requires ability to communicate and interact across facilities and at various levels. Incumbent will have skills to mentor less experienced team members. As is typical in this industry, variable shifts and hours and responding to after-hours notifications may be required. PREFERRED QUALIFICATIONS Certification in two or more of the following areas: Systems Security Certified Practitioner (SSCP), HealthCare Information Security & Privacy Practitioner, (HCISPP), CompTIA Security+, Certified Information Systems Security Professional (CISSP) - Engineering (ISSEP), Certified Ethical Hacker (CEH), SANS GIAC, or Certified Information Systems Auditor (CISA). Three plus years as a System Administrator, Security Operations or in IT Operations. Or three plus years in risk management or GRC experience in the healthcare/medical environment. Must also possess three plus years' experience in a healthcare environment or an equivalent combination of relevant education, technical, business and healthcare experience. Additional related education and/or experience preferred. Anticipated Closing Window (actual close date may be sooner): 2026-05-15 EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

100% Remote NP or PA - Hospitalist Nocturnist Hospitalist APP Nocturnist is a key member of the adult hospitalist team at St. Cloud Hospital, providing overnight care to support safe, efficient, and patient-centered hospital operations. This role primarily manages cross-cover responsibilities for admitted patients and ensures timely response to urgent clinical needs. This position may be performed 100% remote/virtual for qualified candidates Schedule information: * 1.0 FTE * Monday - Thursday (4 nights) * Overnights - 10:00pm - 8:00am CST * No weekends * Remote or on-site at St. Cloud Hospital, if preferred. Job functions: * Independently assess and manage routine clinical issues for already admitted inpatients (e.g., pain, fever, electrolyte replacement, vital sign changes, medication adjustments) * Escalate complex or urgent issues to the on-site overnight hospitalist team as appropriate. * Serve as the first point of contact for nursing concerns overnight, ensuring clear, timely, and collaborative communication. * Partner with on-site overnight hospitalist team to prioritize clinical tasks. * Follow hospital protocols and best practices to ensure high standards of patient care and safety. * Supports and implements patient safety and other safety practices as appropriate. Requirements: * Must be a Nurse Practitioner or Physician Assistant eligible for license in Minnesota. Successfully completed a formal program approved by a national accrediting agency and be certified by a national certification organization recognized by the Minnesota State. * Minimum 3 years inpatient hospital medicine experience, including managing cross-cover duties. * ACLS, BLS, and DEA * EPIC experience preferred * Applicants must reside in a location supported by the CentraCare employment and compliance requirements. Pay and Benefits: * Starting pay begins at $135609.76 per year; exact wage determined by years of related experience * Salary range: $135,609.76 - $174,048.16 per year * Salary and salary range are based on a 1.0 FTE, reduced FTE will result in a prorated offer rate * Full-time benefits: medical, dental, PTO, retirement, employee discounts and more! CentraCare CentraCare is committed to the patients and families we serve in the communities we call home throughout Central, West Central and Southwestern Minnesota. We listen then serve, we guide and heal-because health means everything. * Has grown to be one of the largest health systems in Minnesota * Leading provider of rural health in the state * Recent investment in system-wide employee culture * Innovative population health and wellness initiatives * Collaborative physician and administration leadership model * Access to more than 40 medical and surgical specialties * Work for an organization that offers nationally recognized care. View our most recent awards by clicking here. ******************************************************** CentraCare - St. Cloud Hospital * Access to a regional referral center of 489 beds and Level II trauma center * Highly skilled, specialized support staff and nursing - Magnet designated since 2004 * Offers a full spectrum of inpatient and outpatient services, from primary care to specialty care * Single hospital community For More Information, Visit These Links About CentraCare ************************************ CentraCare Physician & APP Recruitment ************************************************* CentraCare has made a commitment to diversity in its workforce. All individuals including, but not limited to, individuals with disabilities, are encouraged to apply. CentraCare is an EEO/AA employer.

Department Name: Digital Transform Fdn Clin App Work Shift: Day Job Category: General Operations Estimated Pay Range: $19.00 - $19.00 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Find your path in health care. We want to change the lives of those in our care - and the people who choose to take on this challenge. If you're ready to change lives, we want to hear from you. This is a temporary part-time Internship position working in either Colorado or Arizona, 20hr/wk, typically 8:00a-1:00pm with some flexibility. This opportunity is open to Graduate level students pursuing degrees in Health Informatics, Data Analytics, Public Health, or related field, with strong analytical skills, attention to detail, and experience with Python. In this internship you will have the opportunity to work with our Quality Improvement team by reviewing and validating datasets prior to submission to National and State Registries. * Please note the email you apply with is where all updates and information will be sent to, even after you graduate. We recommend applying with a personal email rather than a school email address. Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position typically will be up to one year in length and will work under the direct supervision of a department manager or designee. The position is responsible for expanding experiences and knowledge of practices and procedures as they relate to assigned department and area of study. These activities may include participation in a wide variety of projects. CORE FUNCTIONS 1. Expands and develops knowledge with exposure to a variety of roles related to area of study. 2. Participates on work teams, contributes to projects and initiatives, and performs various tasks as needed by the assigned unit/department. 3. Performs research and prepares reports on assigned topics and /or projects when required. 4. Works as a member of a team providing service to internal and external customers. MINIMUM QUALIFICATIONS Currently enrolled in an accredited college program with course work related to the internship or general knowledge normally obtained through the completion of a college degree. Must demonstrate effective verbal and written communication skills. Must have general knowledge related to the department/unit/area of study. PREFERRED QUALIFICATIONS Proficiency with commonly used office software and personal computers may be necessary, depending on assignment. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

UPMC Community Care Behavioral Health is hiring a full-time Contract Specialist III. This role will work in a hybrid structure, reporting to the office a few days per week. Occasional travel may also be required at times. The Contract Specialist III is responsible for facilitating a seamless process from the time a provider is identified as needed in the network to contracting with the provider for services. The Contract Specialist III reviews and approves any alterations in the status of contracted providers that may impact on their ability to continue to be in the provider network including changes in license, certifications, Medical Assistance enrollment and completing precedential requirements. Maintains the contract files for all provider types. The Contract Specialist III will provide full training for new staff. Responsibilities: + Respond to inquiries regarding provider network from other internal departments such as Marketing and Government Programs. + Assure that provider contracts are fully executed by both parties and that contract copies are filed. + Coordinate the addition of new provider demographic information into UPMC Health Plan systems. + Review and approve specific inquiries related to credentialing and/or provider data maintenance. + Participate in projects as assigned by Supervisor or Manager. + Provide support to the Network and Vendor Relations Department by responding to inquiries from internal and external customers. + Review provider applications, request missing information, and submit completed application to credentialing. + Understand and train new staff on UPMC Health Plan products, policies and procedures including departmental policies. + Coordinate the execution of electronic contracts to providers relating to contracting issues or contract changes. + Coordinate provider file changes with the provider information department. + Bachelor's degree and 5 years relevant experience or 9 years of equivalent work experience required. Preference will be given to those with a Bachelors degree. + Behavioral health experience is strongly preferred. + Prior contracting and/or provider networking experience is a bonus. + Prior experience in health insurance is a bonus. + Thorough knowledge of NCQA standards and other relevant external quality standards. + Knowledge of state and federal standards for contracting. + Knowledge of Provider Types. + Knowledge with experience in contracting with providers for services. + Excellent written and oral communication skills. + Ability to work independently and to analyze complex situations accurately and in a timely manner. + General knowledge of managed care functions and management techniques preferred. + Computer Skills with proficiency in Microsoft Office including: Internet Explorer, Excel, Word, Powerpoint, Visio and Access Software packages.Licensure, Certifications, and Clearances:UPMC is an Equal Opportunity Employer/Disability/Veteran

UPMC Health Plan has an exciting opportunity for a Clinical Auditor/Analyst Intermediate! The Clinical Auditor/Analyst Intermediate is an integral part of the Special Investigations Unit (SIU) and is responsible for conducting clinical audits and reviews regarding the analysis of care and services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization. This role also acts as a SME for the department in representing management in meetings, training new staff and auditing peers. Collects program data to monitor/ensure compliance requirements and establishes and revises better best practice within the department. The Clinical Auditor/Analyst Intermediate creates, maintains and analyzes auditing reports related to their assigned work plan and communicates the results with management. Other responsibilities include but are not limited to analysis of controlled substance prescribing and utilization to identify potential clinical care issues; prepayment review of claims, and prepayment review of unlisted codes. Claims analysis and the use of fraud and abuse detection software tools will be an integral part of the function of this position. Responsibilities will involve working in collaboration with appropriate Health Plan departments including Quality Improvement, Legal, and Medical Management to facilitate the resolution of issue or cases. Responsibilities may involve multiple line of business focused reviews, or ad hoc reviews as needed; analysis of billing by providers/physicians, and providing trending, analysis and reporting of auditing data. The Clinical Auditor/Analyst Intermediate will routinely interact with providers, law enforcement and/or regulatory entities in the course of their duties. Responsibilities: + Respond to fraud, waste, and abuse referrals and/or complete data analysis and related audits as assigned. + Utilize fraud detection software to assess and monitor for potential FWA. + Review and analyze claims, medical records and associated processes related to the appropriateness of coding, clinical care, documentation, and health plan business rules. + Provide a clinical opinion for special projects or various issues including appropriate utilization of controlled substances, prescribing of controlled substances, or medically appropriate services. + Query medical and/or pharmacy claims and conduct a risk assessment by performing data analysis and applying applicable coding guidelines, Health Plan policies and any applicable National Coverage Determination (NCD) or Local Coverage Determination (LCD). + Evaluate referrals from Pharmacy Benefit Manager (PBM) by analyzing medical and pharmacy claims and associated clinical documentation in HealthPlaNET, Mars, Epic and/or Cerner. + Complete audits by utilizing standard coding guidelines and principles and coding clinics to verify that the appropriate CPT codes/DRGs were assigned and supported in the medical record documentation. + Attend in person or virtual recipient restriction hearings. + Review Medical Pended Queue claims to understand and resolve claim referral issues through research and interaction with other Health Plan Departments including Medical Management, Medical Directors, various committees, and other appropriate Health Plan departments. + As necessary, assist in the development of new policies concerning future Health Plan payment of identified issue. + Assess, investigate and resolve complex issues. + Write concise written reports including statistical data for communication to other areas of UPMC Health Plan and to communicate with department heads for identification of various problem issues, how they affect the Health Plan, and to make recommendations for resolution of the issue. + Identify error trends to determine appropriate training needs and suggest modifications to company policies and procedures. + Conduct provider education, as necessary, regarding audit results. Communicate effectively with Medical Directors and ancillary departments as necessary to address issues and concerns. + Participate as needed in special projects and other auditing activities. Provide assistance to other departments as requested. + Understand customers including internal Health Plan Departments (i.e. Claims staff, Customer Service, Marketing, etc.) and external customers (i.e. Health System Internal Audit, Client Audit teams) to understand issues, identify solutions and facilitate resolution. + Serve as an SIU representative at internal and external meetings, document and present findings to SIU Staff and document as appropriate in the SIU FWA Case Management Database. + Assist in the development and revision of SIU policies and procedures. Identify trends for improvements internally, such as claims payment, to determine appropriate training needs and suggest modification to company policies and procedures. + Perform audit peer reviews for Clinical Auditor/Analysts. + Provide new-hire training to Clinical Auditor/Analysts. Performing administrative appeals/preparing medical necessity appeals for Medical Directors for second level appeals. Participate in training programs to develop a thorough understanding of the materials presented. + Obtain CPE or CEUs to maintain nursing license, and/or professional designations. + Design and maintain reports, auditing tools and related documentation. Maintain or exceed designated quality and production goals. Maintain employee/insured confidentiality. Registered Nurse (RN). Bachelor of Science in Nursing (BSN) or the equivalent combination of education, professional training and work experience. Five years of clinical experience. Three years of fraud & abuse, auditing, case management, quality review or chart auditing experience required. Ability to analyze data, maintain designated production standards, and organize multiple projects and tasks. In-depth knowledge of medical terminology, ICD-10 and CPT-4 coding. Knowledge of health insurance products and various lines of business. Detail-oriented individual with excellent organizational skills. Keyboard dexterity and accuracy. High level of oral and written communication skills. Proficiency with Microsoft Office products (Excel, Access, OneDrive, OneNote and Word). Licensure, Certifications, and Clearances: AAPC or AHIMA Certified (CPC, CPMA, CIC, CCA, CCS, CCS-P) or AHFI designation required. + Registered Nurse (RN) + Act 33 with renewal + Act 34 with renewal + Act 73 FBI Clearance with renewal *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state. UPMC is an Equal Opportunity Employer/Disability/Veteran

Department Name: Accounting-Corp Work Shift: Day Job Category: General Operations Estimated Pay Range: $17.00 - $17.00 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. A rewarding career that fits your life. As an employer of the future, we are proud to offer our team members many career and lifestyle choices including remote work options. If you're looking to leverage your abilities - you belong at Banner Health. The Accounting/Finance Undergrad Intern will assist the Accounting team with assigned tasks as they navigate a global Workday Implementation slated to last until February 2027. Many of our Accounting/Financial Undergrad Interns are offered permanent roles with Banner Health once they complete schooling. Ideal candidate: Accounting/Finance major within 2 semesters of completion; Have a desire to be paid while learning key Accounting and Financial principles and strategies in the healthcare industry; Dedicated and hard working; Take direction well. SHIFT: Monday - Friday; 20-25 hours each week. Any combination of hours between 6am-7pm AZ Time. Flexible position, with ability to work around your school schedule. REMOTE position if you live in the following state(s) only: AZ, CA, NV, CO, WY, NE Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY This position typically will be up to one year in length and will work under the direct supervision of a department manager or designee. The position is responsible for expanding experiences and knowledge of practices and procedures as they relate to assigned department and area of study. These activities may include participation in a wide variety of projects. CORE FUNCTIONS 1. Expands and develops knowledge with exposure to a variety of roles related to area of study. 2. Participates on work teams, contributes to projects and initiatives, and performs various tasks as needed by the assigned unit/department. 3. Performs research and prepares reports on assigned topics and /or projects when required. 4. Works as a member of a team providing service to internal and external customers. MINIMUM QUALIFICATIONS Currently enrolled in an accredited college program with course work related to the internship or general knowledge normally obtained through the completion of a college degree. Must demonstrate effective verbal and written communication skills. Must have general knowledge related to the department/unit/area of study. PREFERRED QUALIFICATIONS Proficiency with commonly used office software and personal computers may be necessary, depending on assignment. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

UPMC is looking for a Network Convergence Engineer -Intermediate to join their team. This position will be primarily ON-SITE, you will work 4 days a week ON-SITE and get 1 day a week to work remote/from home. We are targeting local candidates in and around the PA area. Description The Converged Network Engineer - Intermediate works closely with all UPMC departments and business units, ISD departments and/or groups, as required, to meet business objectives, resolve problems, provide technical assistance in accordance with assigned responsibilities, and when necessary, coordinates with other telecommunications resources in carrying out the assigned responsibilities. This position also interacts with vendors and suppliers. Responsibilities: + Functions in an upper level position, with responsibility for timely service delivery as well as project management. + Work on medium to large-scale projects in addition to providing services, as determined by the management team. + Possesses advanced knowledge of the PBX system, voice mail and wiring support design and function. Provides technical assistance to departmental personnel, clients, vendors, and other parties as assigned. + Interfaces with others on system infrastructure problems and advises management on technical problems, priorities, and methods. + Contributes to systems infrastructure plans based on an understanding of the customer's organizational direction, technical context and business needs. + Participates in day-to-day orders, Special Projects, and trouble tickets to include Move, Add, and Change requests for the data and/or voice network. + Contributes to the creation of new policies and procedures for Maintenance Plan and Continuity of Operations Plan. + Provides network performance statistics and reports and recommends technical enhancements to the network. + The Converged Engineer - Intermediate is responsible for handling and working in all aspects of the UPMC Enterprise Communications Group. This includes responsibilities on the telephony systems, PBXs, data networks, wireless networks, and data network infrastructure. Converged Network Engineers are responsible for using Nokia, Cisco, Alcatel-Lucent, and Avaya products, as well as a working knowledge of encryption solutions, private branch exchanges (PBX), and local and wide area networks and wireless networks (LAN/WAN/WLAN). + Reviews, organizes, communicates and records all requests for voice services. + Responsible for creating, managing, tracking, and reporting the status of assigned projects, using the specified project management software. Coordinates, with other Engineers in the delivery to telecommunications and networking services. + Reviewing, organizing, communicating and recording requests for Telecommunications systems, including adds, moves and changes on PBX, Voice Mail, Networking, wiring support, and maintenance of all voice related databases at UPMC and affiliated business units. + Constructs, tests and implements integrated network, hardware and software solutions, distributed computing solutions, and/or physical and logical communications networks for the customer. + Researches, evaluates and stays current on emerging tools, techniques and technologies. + Responsible for the day to day maintenance and support of the data communications equipment and systems within UPMC and affiliated business units for connectivity requests and/or reported problems. + Ensures customer satisfaction with the resolution or circumvention of hardware, software, and/or circuit problems including the assessment of bandwidth requirements based upon empirical data. + Configuration of data communications devices, design and implementation of local and wide area networking, problem determination knowledge in these areas. Qualifications * Typically has 2+ years of converged communications infrastructure design and support experience. * Required Experience/Skills/Attributes: o Experience conducting site surveys and organizing the documentation into an Engineering Plan. o Up-to-date Avaya voice product experience. o Up-to-date PBX experience. * Hands-on skills to include: o Aura Communication Manager, ACD call center, CMS, unified messaging, SIP/H.323 trunking, SIP services, G430/450, S8800. o Intermediate to expert level skills required in networking to support converged applications including voice/video/WLAN Strong interpersonal, written and oral skills. o From time to time, candidates may be asked to present project outline to customers. o Ability to conduct research on products with various vendors to accommodate changing customer requirements. o Ability to work in a team-oriented collaborative environment while being highly motivated to take the lead on projects. * Desired Experience/Skills/Attributes: o Experience with Microsoft products including Windows 2000 Server, Active Directory, and Exchange Unified Messaging would be a plus. o Experience with Cisco Enterprise solution products. o Understanding of Cisco router, switch, and ASA products. o Ability to troubleshoot access-lists, IPv4 and IPv6 issues across varying protocols such as OSPF, BGP, and Static Routing. o Hands-on administration experience with Linux/Solaris Licensure, Certifications, and Clearances: Act 34 Preferred Licensure: CCNA - Cisco Cert Networking Assoc NRS1 - Nokia Ntwrk Routing Spec I ACIS - Avaya Cert Integration Spec ACCA - Avaya Call Center Admin CXTECH - AVST Certified CX Tech SBCADMIN - Avaya SBC Admin ITIL - IT Infrastructure Library UPMC is an Equal Opportunity Employer/Disability/Veteran

Department Name: Banner Staffing Services-AZ Work Shift: Day Job Category: Administrative Services Estimated Pay Range: $20.01 - $30.01 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. "Banner Staffing Services (BSS) offers Registry/Per Diem opportunities within Banner Health. Registry/Per Diem positions are utilized as needed within our facilities. These positions are great way to start your career with Banner Health. As a BSS team member, you are eligible to apply (at any time) as an internal applicant to any regular opportunities within Banner Health. Learn more at **************************** As a Senior Service Center Representative for Banner Plans & Networks you will take inbound calls answering member and provider questions regarding coverage, benefits, claims, and other plan inquiries. You will be working in a fast paced and multitasking environment. You will provide excellent customer service and satisfaction with a goal of first call resolution. As a Senior Service Center Representative, you will be working in a remote setting. Your shifts will be Monday-Friday between 8am-8pm, Arizona Time Zone. (Some after-hours or weekends may be required for certain types of training. Advanced notification will be provided when this is necessary.) Please note Banner Staffing Services roles do not offer medical benefits or paid time off accrual. These roles are assignment based with no guarantee of hours and assignments can conclude at any time. If this role sounds like the one for you, Apply Today! As a valued and respected Banner Health team member, you will enjoy: Competitive wages Paid orientation Flexible Schedules (select positions) Fewer Shifts Cancelled Weekly pay 403(b) Pre-tax retirement Resources for living (Employee Assistance Program) MyWell-Being (Wellness program) Discount Entertainment tickets Restaurant/Shopping discounts Registry/Per Diem positions do not have guaranteed hours and no medical benefits package is offered. Completion of post-offer Occupational Health physical assessment, drug screen and background check (includes employment, criminal and education) is required. POSITION SUMMARY This position provides leadership and expertise to the representatives providing customer service to providers and members of benefit plans; supports the development of the company health plans as well as the staff by coordinating the training, documentation, client communication techniques, and other resources necessary to ensure an excellent quality of service. This position serves as a primary resource in complex and/or sensitive cases and takes escalated calls. May be assigned to work in a variety of team leadership, work flow management and/or quality assurance functions. CORE FUNCTIONS 1. Provides customer service, researches and solves problems for escalated calls and member or provider issues requiring investigation and problem solving. 2. Provides training and informational/reference resources for the service center. 3. Maintains records, tracks cases, issues correspondence and log events for assigned area of benefits services. 4. Provides direction and leadership in daily work and workflow of a service center team. 5. Works on special projects as assigned. 7. Works under limited supervision to provide for diverse customer service needs for multiple benefit plans. Interprets company and contracted managed care organization policy and procedure. Makes decisions within structured definitions and defined policy. This position manages diverse customer needs while positioning services and programs as the preferred choice for meeting the stated needs. This position independently interprets benefits and managed care policies and procedures and communicates accordingly to customer base, following general guidelines and standards, this position will determine appropriate action to meet customer needs. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent working knowledge. Must have substantial previous related work experience in managed care benefits member/provider services work are required, with three to fours years of experience in a high volume service center or managed care environment, preferably with self-insured plans. Must possess excellent communication skills to handle moderately complex inquiries, while maintaining a positive and helpful attitude. Requires the ability to handle a high volume of incoming calls, search the database or resources tools for correct and timely information, and maintain a professional demeanor all times. Must have the ability to learn and effectively use the company's customer information systems, as well as developing and maintaining a fundamental knowledge of the organization's benefit plans. PREFERRED QUALIFICATIONS Experience working with self insured plans is highly preferred. Bilingual Spanish/English skills are a plus. Additional related education and/or experience preferred. EEO Statement: EEO/Disabled/Veterans Our organization supports a drug-free work environment. Privacy Policy: Privacy Policy

Atlantic Health is seeking a skilled and dedicated Plain Film Radiologist to join our radiology team. This is a fully remote position ideally suited for candidates looking for work-life balance. Enjoy the flexibility of working from home while contributing to a high-performing, patient-centered organization. Hours are flexible and call is optional. Part time and full-time options are available. Successful candidates will work with cutting-edge technology including multiple AI applications. As a Radiologist with Atlantic Health System, you will have access to a diverse patient population and a wide range of cases. We are committed to providing our patients with the highest quality care and are looking for radiologists who share our dedication to excellence. Full-Time Salary Range: $300,000-$400,000 base salary only; excludes any quality and/or productivity incentives. To learn more about this position and other opportunities with Atlantic Health System, please send your CV to Lori Velasco, Physician Recruiter at *******************************. Qualifications: Board-certified or board-eligible by the American Board of Radiology Must be licensed or eligible for licensure in the State of New Jersey Benefits Competitive salary Robust benefits with health, dental, Rx and vision plans 403b retirement plan with company match Reimbursement for Relocation Comprehensive Malpractice Policy Non-Profit Health System - eligible for Federal Student Loan Forgiveness Annual CME and Time Off incremental to PTO days Full reimbursement for Boards and Licensing fees Tuition reimbursement for Advanced Degrees Voted “Great Place to Work “- 16 years strong! Outstanding growth & mentorship opportunities Qualifications Qualifications Board certified by the American Board of Radiology Must be licensed or eligible for licensure in the State of New Jersey